Skip to main content
SpringerLink
Log in

Elastisch stabile intramedulläre Nagelung

Möglichkeiten und Grenzen eines Osteosyntheseverfahrens

Elastic stable intramedullary nailing

Possibilities and limits of osteosynthesis treatment

  • Standards in der Unfallchirurgie
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Besteht die Indikation zur operativen Stabilisierung einer Schaftfraktur der langen Röhrenknochen am wachsenden Skelett, ist die elastisch stabile intramedulläre Nagelung (ESIN) – unter Berücksichtigung der Korrekturmöglichkeiten und der Wachstumsprognose des verletzten Knochens – ein etabliertes Osteosyntheseverfahren. Es gilt hierbei, die biomechanischen Grenzen des Verfahrens zu beachten sowie zwischen geeigneten und weniger geeigneten Indikationen zu unterscheiden. Geeignete Indikationen für die ESIN sind v. a. die dislozierten längsstabilen Quer- und die kurzen Schrägfrakturen der langen Röhrenknochen der oberen und unteren Extremität. Längsinstabile Schaftbrüche im Sinne einer langen Schräg-, Spiral- oder Mehrfragmentfraktur sind für dieses Verfahren weniger geeignet. Denn es gewährleistet v. a. an der unteren Extremität keine ausreichende primäre Längsstabilität, somit kann bei diesen Verletzungen das Ziel der frühzeitigen Belastbarkeit vor der knöchernen Konsolidierung nicht erreicht werden.

Abstract

If there is an indication for surgery with reduction and stabilization in long bone shaft fractures in children, elastic stable intramedullary nailing (ESIN) is an established treatment. It is necessary to pay attention to the biomechanical limits of the method and to differentiate between optimal and suboptimal indications. Optimal indications for ESIN are dislocated longitudinal stable shaft fractures of the upper and lower limb, e.g., transverse fractures or short oblique fractures. Longitudinal unstable shaft fractures (e.g., drawn out oblique fractures, spiral fractures, or comminuted fractures) are suboptimal indications for ESIN because sufficient longitudinal stability is not provided so that the primary aim of early weight bearing can not be achieved.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6

Literatur

  1. Ballal MS, Garg NK, Bruce CE, Bass A (2009) Nonunion of the ulna after elastic stable intramedullary nailing for unstable forearm fractures: a case series. J Pediatr Orthop B 18(5):261–264

    Article  PubMed  Google Scholar 

  2. Dietz HG, Schlickewei W (2011) Femurschaftfrakturen im Kindesalter. Unfallchirurg 114(5):382–387

    Article  PubMed  Google Scholar 

  3. Dietz HG, Schmittenbecher PP, Slongo T, Wilkins KE (2006) Elastic stable intramedullary nailing (ESIN) in children. Thieme, Stuttgart New York

  4. Fernandez FF, Eberhardt O, Langendörfer M, Wirth T (2009) Nonunion of forearm shaft fractures in children after intramedullary nailing. J Pediatr Orthop B 18(6):289–295

    Article  PubMed  Google Scholar 

  5. Fernandez FF, Eberhardt O, Wirth T (2010) Elastic stable intramedullary nailing as alternative therapy for the management of paediatric humeral shaft fractures. Z Orthop Unfall 148(1):49–53

    Article  PubMed  CAS  Google Scholar 

  6. Fernandez FF, Langendörfer M, Wirth T, Eberhardt O (2010) Failures and complications in intramedullary nailing of children’s forearm fractures. J Child Orthop 4(2):159–167

    Article  PubMed  CAS  Google Scholar 

  7. Griffet J, Leroux J, Boudjouraf N et al (2011) Elastic stable intramedullary nailing of tibial shaft fractures in children. J Child Orthop 5(4):297–304

    Article  PubMed  Google Scholar 

  8. Hedin H, Larsson S (2003) Muscle strength in children treated for displaced femoral fractures by external fixation: 31 patients compared with 31 matched controls. Acta Orthop Scand 74(3):305–311

    Article  PubMed  Google Scholar 

  9. Kaiser MM, Zachert G, Wendlandt R et al (2011) Biomechanical analysis of a synthetic femoral spiral fracture model: do end caps improve retrograde flexible intramedullary nail fixation? J Orthop Surg Res 6:46

    Article  PubMed  Google Scholar 

  10. Kaiser MM, Zachert G, Wendlandt R et al (2012) Increasing stability by pre-bending the nails in elastic stable intramedullary nailing: a biomechanical analysis of a synthetic femoral spiral fracture model. J Bone Joint Surg Br 94(5):713–718

    Article  PubMed  CAS  Google Scholar 

  11. Kraus R, Pavlidis T, Szalay G et al (2007) Elastic stable intramedullary nailing (ESIN) in pediatric forearm shaft fractures: intraoperative image intensifier times. Z Orthop Unfall 145(2):195–198

    Article  PubMed  CAS  Google Scholar 

  12. Laer L von (1985) Classification, diagnosis, and treatment of transitional fractures of the distal part of the tibia. J Bone Joint Surg Am 67(5):687–698

    Google Scholar 

  13. Laer L von, Kraus R, Linhart WE (2007) Frakturen und Luxationen im Wachstumsalter. Thieme, Stuttgart New York

  14. Lascombes P, Prevot J, Ligier JN et al (1990) Elastic stable intramedullary nailing in forearm shaft fractures in children: 85 cases. J Pediatr Orthop 10(2):167–171

    PubMed  CAS  Google Scholar 

  15. Lascombes P, Haumont T, Journeau P (2006) Use and abuse of flexible intramedullary nailing in children and adolescents. J Pediatr Orthop 26(6):827–834

    Article  PubMed  Google Scholar 

  16. Lee SS, Mahar AT, Newton PO (2001) Ender nail fixation of pediatric femur fractures: a biomechanical analysis. J Pediatr Orthop 21(4):442–445

    PubMed  CAS  Google Scholar 

  17. Metaizeau JP (2004) Stable elastic intramedullary nailing for fractures of the femur in children. J Bone Joint Surg Br 86(7):954–957

    Article  PubMed  CAS  Google Scholar 

  18. Nectoux E, Giacomelli MC, Karger C et al (2008) Use of end caps in elastic stable intramedullary nailing of femoral and tibial unstable fractures in children: preliminary results in 11 fractures. J Child Orthop 2(4):309–314

    Article  PubMed  CAS  Google Scholar 

  19. Reynders P, Reynders K, Broos P (2002) Pediatric and adolescent tibial eminence fractures: arthroscopic cannulated screw fixation. J Trauma 53(1):49–54

    Article  PubMed  Google Scholar 

  20. Roposch A, Linhart WE (2002) Ender nail fixation of pediatric femur fractures: a biomechanical analysis. J Pediatr Orthop 22(4):556–557

    PubMed  CAS  Google Scholar 

  21. Salem KH, Keppler P (2010) Limb geometry after elastic stable nailing for pediatric femoral fractures. J Bone Joint Surg Am 92(6):1409–1417

    Article  PubMed  Google Scholar 

  22. Schmittenbecher PP, Dietz HG, Linhart WE, Slongo T (2000) Comlications and problems in intramedullary nailing of children’s fractures. Eur J Trauma 26:287–293

    Article  Google Scholar 

  23. Schmittenbecher PP, Fitze G, Gödeke J et al (2008) Delayed healing of forearm shaft fractures in children after intramedullary nailing. J Pediatr Orthop 28(3):303–306

    Article  PubMed  Google Scholar 

  24. Sink EL, Gralla J, Repine M (2005) Complications of pediatric femur fractures treated with titanium elastic nails: a comparison of fracture types. J Pediatr Orthop 25(5):577–580

    Article  PubMed  Google Scholar 

  25. Slongo TF (2005) The choice of treatment according to the type and location of the fracture and the age of the child. Injury [Suppl 1] 36:A12–19

    Google Scholar 

  26. Slongo TF (2008) Ante- and retrograde intramedullary nailing of humerus fractures. Oper Orthop Traumatol 20(4–5):373–386

    Google Scholar 

  27. Volpon JB, Perina MM, Okubo R, Maranho DA (2012) Biomechanical performance of flexible intramedullary nails with end caps tested in distal segmental defects of pediatric femur models. J Pediatr Orthop 32(5):461–466

    PubMed  Google Scholar 

  28. Weinberg AM, Castellani C, Amerstorfer F (2008) Elastic stable intramedullary nailing (ESIN) of forearm fractures. Oper Orthop Traumatol 20(4–5):285–296

    Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. BG-Unfallklinik Duisburg, Großenbaumer Allee 250, 47249, Duisburg, Deutschland

    B. Veigel, R. Kraus, C. Illian & D. Rixen

Authors
  1. B. Veigel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Kraus
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Illian
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D. Rixen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. Veigel.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Veigel, B., Kraus, R., Illian, C. et al. Elastisch stabile intramedulläre Nagelung. Trauma Berufskrankh 14, 284–291 (2012). https://doi.org/10.1007/s10039-012-1921-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10039-012-1921-6

Schlüsselwörter

Keywords

Search

Navigation